Impact of Machine Perfusion on Liver Transplantation for Hepatocellular Carcinoma

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

Am J Transplant

Abstract

Extended criteria donor grafts are more susceptible to ischemic-reperfusion injury and are associated with worse post-transplant outcomes. Existing studies on use of machine perfusion (MP) in patients with hepatocellular carcinoma (HCC) undergoing transplantation is limited, though some data suggests ischemic damage in the transplant liver might increase the risk for cancer recurrence. Use of MP for patients with HCC potentially improves overall and oncological outcomes in this population. In this study, we analyzed a large national database to evaluate the role of MP on post-transplant outcomes in patients with HCC. Adults transplanted with a diagnosis of HCC between 2015 and 2022 from the United Network for Organ Sharing (UNOS) database were divided into two populations, based on use of MP for the procured liver. Post-transplant outcomes assessed included: overall survival (OS) and HCC recurrence (competing-risk) using Cox regression and Fine-Gray models, respectively. HCC recurrence was defined from the UNOS database by merging the two reported follow up outcomes: cause of death related to HCC or post-transplant recurrence of malignancy. Of the 15,374 patients with HCC who underwent liver transplant and had MP data, 284 (1.8%) used MP for the donor liver. The 3-year OS was significantly higher with MP use (93.0% in MP group versus 86.2% no MP; p=0.03) (Figure 1). Cox hazard regression model for 3-year OS showed that use of MP reduced risk of death, independent of HCC recurrence (hazard ratio 0.62 95% confidence interval 0.40-0.97; p=0.035). The use of MP was not related to 3-year HCC recurrence on competing risk analysis (recurrence and death) (3-year recurrence rate: 2.1% in MP group versus 4.2% no MP, p=0.50). Overall, only a small proportion of patients with HCC had liver transplant with use of MP in the donor liver. However, this group demonstrated significantly better 3-year OS, without significant difference in HCC recurrence. HCC recurrence might be underreported or uncaptured in the UNOS data, therefore, as the utilization of MP grows, further investigations into possible associations between HCC recurrence and improved survival outcomes in the MP group would be warranted. [Formula presented] DISCLOSURES: L. Rajendran: None. R. Oki: None. E. Kerby: None. A. Nassar: None. A. Mohamed: None. A. Al-Kurd: None. A. Yoshida: None. M. Abouljoud: None. S. Nagai: None.

Volume

25

Issue

1

First Page

S68

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